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This study sought to investigate the relationship between multiple preoperative characteristics of pain (maximum pain severity location, the presence of pain in certain locations, the highest level of pain, and the number of pain locations) and psychological outcome measures as reported by patients. Fifty-four hips (50 patients) that underwent periacetabular osteotomy to treat acetabular dysplasia between February 2017 and July 2020 were reviewed using the Depression, Anxiety, and Stress Scale-21 (DASS21), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS), radiographic analysis, and questionnaires concerning pain severity/location. Twenty-six hips had their worst pain in the groin, whereas 28 hips had greater or equal levels of pain at another location. There was no significant difference between these two locations on any of the postoperative psychological outcomes (HADS, P =.53; DASS21, P =.85; PCS, P =.97). Additionally, there was not a significant relationship between pain in any location other than the groin and any postoperative psychological outcomes ( P ≥.08). Finally, the highest level of preoperative pain and the number of locations of pain demonstrated no significant relationship with postoperative psychological outcomes (maximum severity: HADS, P =.28; DASS21, P =.49; PCS, P =.57; number of pain locations: HADS, P =.47; DASS21, P =.60; PCS, P =.35). Variance in preoperative pain location, severity, and number of pain locations seemingly does not result in any significant effect on postoperative psychological outcomes. Thus, a large range of patients with acetabular dysplasia may experience similar, favorable psychological outcomes from treatment with periacetabular osteotomy notwithstanding the characteristics of preoperative pain. [ Orthopedics . 202x;4x(x):xx–xx.]

Pelvic tilt is thought to be a compensatory mechanism in hip pathology, specifically in patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. This study investigated the relationship between preoperative pelvic tilt and postoperative outcomes in patients undergoing hip preservation surgery for FAIS or hip dysplasia. We reviewed a prospective hip preservation database for demographic, radiographic, and outcome data for 89 patients who underwent hip preservation surgery with a primary diagnosis of FAIS or dysplasia from 2016 to 2020. Pelvic tilt was assessed on the standing anteroposterior radiograph with the pubic symphysis to sacroiliac joint (PS-SI) distance measurement. The International Hip Outcome Tool 12 (iHOT-12), Hip Outcome Score, Harris Hip Score, UCLA activity score, and European Quality of Life–Visual Analog Scale were used to assess hip function and pain preoperatively and postoperatively. The mean pelvic tilt (PS-SI distance) was 86.4±18.3 mm for the FAIS group and 96.2±15.1 mm for the dysplasia group. The statistical analysis demonstrated a positive relationship between pelvic tilt and change in iHOT-12 score ( r s =0.262, P =.019) for all 89 patients with hip pathology and, separately, a trend toward significance for the 42 patients with FAIS ( r s =0.330, P =.056). No other significant relationships were observed. The improvement in iHOT-12 score was greater for patients with more anterior tilt and less for patients with posterior pelvic tilt, regardless of underlying hip etiology. These results provide intriguing insights into an initial investigation on pelvic tilt in patients undergoing hip preservation surgery. Further investigation is necessary to assess pelvic tilt preoperatively and postoperatively, spinal parameters, and longer-term outcomes. [ Orthopedics . 202x;4x(x):xx–xx.]

Factors influencing the clinical outcomes after periacetabular osteotomy (PAO) have not been well explored. This study evaluated the influence of symptom duration in developmental dysplasia of the hip on short-term patient-reported outcomes after PAO. A retrospective review of prospectively collected data identified PAOs performed on 139 patients. Sixty-five patients were then stratified into two groups based on preoperative symptom duration: 2 years or less (n=22) vs more than 2 years (n=43). We compared the results of hip-specific patient-reported outcome surveys collected preoperatively and postoperatively. When comparing the two groups, we found no significant differences in clinical outcome scores except for the UCLA Activity Scale. The shorter duration group achieved improvement 6 months postoperatively on the visual analog scale average pain score (from 4.5 to 2.167; P =.0017), International Hip Outcome Tool-12 (from 42.95 to 59.19; P =.0176), and Harris Hip Score (from 53.88 to 69.88; P =.049). The longer duration group also achieved postoperative improvement across multiple surveys. Nevertheless, a multivariate analysis controlling for age, sex, and body mass index and found that symptom duration did not independently affect the change in clinical outcomes. Although PAO leads to improvements in functional status and pain, preoperative symptom duration does not significantly affect these clinical outcomes. [ Orthopedics . 202x;4x(x):xx–xx.]

Diabetic foot and ankle complications contribute to substantial mortality and morbidity. Early detection and treatment can lead to better patient outcomes. The primary diagnostic challenge for radiologists is distinguishing Charcot's neuroarthropathy from osteomyelitis. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessing diabetic bone marrow alterations and for identifying diabetic foot complications. Several recent technical advances in MRI, such as the Dixon technique, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have led to improved image quality and increased capability to add more functional and quantitative information.We discuss the bone marrow abnormalities encountered in daily radiologic assessment: osteopenia, reactive bone marrow edema-like signal, insufficiency fractures, Charcot's neuroarthropathy, osteomyelitis, serous marrow atrophy, digital ischemia, and bone infarcts, along with their pathophysiology and the conventional and advanced imaging techniques used for a comprehensive marrow evaluation.

Bone marrow edema (BME) from dual-energy CT is useful to direct attention to radiographically occult fractures. The aim was to characterize utility of BME of lower extremity (LE) fractures with the hypothesis that stabilized and post-acute fractures exhibit decreased extent and frequency of BME than non-stabilized and acute fractures, respectively.An IRB-approved retrospective review of known LE fractures. A total of 141 cases met inclusion criteria, including 82 fractures without splint/cast stabilization, and 59 cases with stabilization. Two readers independently recorded BME, and its multiplicity and area (mmBME was significantly larger in non-stabilized (859.3 mmBME evaluation can assist in differentiation of acute versus post-acute fractures. Extent of BME is reduced with splint/cast stabilization, which may limit its accuracy in detection of lower extremity fractures.• Evaluation of bone marrow edema on dual-energy CT aids in differentiation of acute versus post-acute fracture. • Bone marrow edema evaluation is limited in the setting of post-acute or stabilized fractures. • There is decreased frequency and extent of bone marrow edema in post-acute, non-comminuted, and stabilized fractures.

We report one- and 2-year results of a prospective, 5-year, multicenter study of radiographic, clinical, and patient-reported outcomes following triplanar first tarsometatarsal arthrodesis with early weightbearing. One-hundred and seventeen patients were included with a mean (95% confidence interval [CI]) follow-up time of 16.6 (15.5, 17.7) months. Mean (95% CI) time to weightbearing in a boot walker was 7.8 (6.6, 9.1) days, mean time to return to athletic shoes was 45.0 (43.5, 46.6) days, and mean time to return to unrestricted activity was 121.0 (114.5, 127.5) days. There was a significant improvement in radiographic measures with a mean corrective change of -18.0° (-19.6, -16.4) for hallux valgus angle, -8.3° (-8.9, -7.8) for intermetatarsal angle and -2.9 (-3.2, -2.7) for tibial sesamoid position at 12 months (n = 108). Additionally, there was a significant improvement in patient-reported outcomes (Visual Analog Scale, Manchester-Oxford Foot Questionnaire, and Patient-Reported Outcomes Measurement Information System) and changes were maintained at 12 and 24 months postoperatively. There was 1/117 (0.9%) reported recurrence of hallux valgus at 12 months. There were 16/117 (13.7%) subjects who experienced clinical complications of which 10/117 (8.5%) were related to hardware. Of the 7/117 (6.0%) who underwent reoperation, only 1/117 (0.9%) underwent surgery for a nonunion. The results of the interim report of this prospective, multicenter study demonstrate favorable clinical and radiographic improvement of the HV deformity, early return to weightbearing, low recurrence, and low rate of complications.

Musculoskeletal neoplasms include tumors arising from bone, cartilage, muscles, tendons, nerves, and synovium. After initial screening radiographs, magnetic resonance (MR) imaging is the mainstay of management, and its role continues to increase in both pre- and post-operative evaluations. This article presents a review of the available qualitative and quantitative MR techniques for evaluating musculoskeletal neoplasms, including conventional and advanced imaging techniques such as diffusion-weighted and diffusion-tensor imaging, chemical shift and Dixon imaging, dynamic contrast-enhanced MRI, neurography, and spectroscopy. After reading the article, radiologists and oncologists will be able to apply these principles in their practices to benefit patients with musculoskeletal neoplasms.

Operative management displaced intra-articular calcaneus fractures is commonly associated with wound complications. Open reduction internal fixation is traditionally performed through the extensile lateral approach has relatively high rates of wound complications. The sinus tarsi approach to displaced intra-articular calcaneus fractures is a less invasive approach to achieve fracture reduction and fixation as well as reduce wound healing complications. The purpose of this study is to report the rates of wound complications associated with the sinus tarsi approach in the treatment of displaced intra-articular calcaneus fractures.We retrospectively identified patients treated with a limited sinus tarsi approach for displaced intra-articular calcaneus fractures from January 2009 to December 2018. Demographic and radiographic data were collected including age, gender, mechanism of injury, occupation, presence of diabetes mellitus, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements.One hundred and five fractures were identified in 100 patients who underwent open reduction internal fixation for displaced intra-articular calcaneus fractures. Using the Sanders computed tomographic classification, we identified 32% Type 2, 48% Type 3, 18% Type 4, and 2% tongue-type variants. For the preoperative Bohler's angle, 38% of fractures displayed a negative angle, 50% had an angle 0° to 20°, and 12% over 20°. Postoperatively, all patients demonstrated an improvement in Bohler's angle with 13% with 0° to 20° and 87% over 20°. Approximately, 72% of patients working prior to the injury had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 11.9% (12/105), with 1.9% (2/105) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p = .55).Operative management of displaced intra-articular calcaneus fractures through the sinus tarsi approach allows restoration of calcaneal height with a low rate of wound complications, even among active smokers.

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This is the first guideline on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes published by the IWGDF. We followed the GRADE Methodology to devise clinical questions in the PACO (Population, Assessment, Comparison, Outcome) and PICO (Population, Intervention, Comparison, Outcome) format, conducted a systematic review of the medical literature, and developed recommendations with the rationale. The recommendations are based on the evidence from our systematic review, expert opinion when evidence was not available, and also taking into account weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to an intervention. We here present the 2023 Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus and also suggest key future topics of research.

ACL reconstruction tunnel location is an important predictor for outcomes after surgery. The aim was to establish 3D and 2D MRI radiological measurements for native ACL tibial footprint that can provide information to facilitate pre-operative planning for anatomical graft placement. The measurements were also correlated in a subset of patients on arthroscopy.Retrospective evaluation of a consecutive series of knee MRIs with both 2D and 3D MR imaging was performed in 101 patients with 43 men and 66 women and ages 39.5 ± 11.9 years. Two measurements were obtained, tibial to ACL and intermeniscal ligament to ACL (T-ACL) and (IM-ACL), respectively. In a cohort of 18 patients who underwent knee arthroscopy, the T-ACL and IML-ACL distances were also determined by an orthopedic surgeon using a standard scale. ICC, Pearson correlation, and Bland-Altman plot were generated.For readers 1 and 2, the mean differences between 2D and 3D measurements of T-ACL and IM-ACL were 1.17 and 1.03 mm and 0.65 and 0.65 mm, respectively. The 2D measurements of T-ACL and IM-ACL were larger than the 3D measurements for both readers. The inter-reader reliability was excellent on 2D (0.81-0.96) and fair to excellent on 3D MRI (0.59-0.90). The mean arthroscopic IML-ACL was closer to that of 3D MRI compared to 2D MRI. The mean arthroscopic T-ACL was closer to 2D MRI than 3D MRI.Both 2D and 3D MRI show inter-reader reliability with small inter-modality mean differences in the measurements from the tibial or inter-meniscal ligament margins.• The mean differences between 2D and 3D measurements of tibia-ACL and intermeniscal ligament-ACL are small (1.2 mm). • As compared to arthroscopy, the mean T-ACL and IML-ACL were closer to measurements from 2D and 3D MRI, respectively. • Both 2D and 3D MRI can be reliably used to delineate ACL foot plate anatomy.

Fascicular targeting of longitudinal intrafascicular electrode (FAST-LIFE) interface enables hand dexterity with exogenous electrical microstimulation for sensory restoration, custom neural recording hardware, and deep learning-based artificial intelligence for motor intent decoding. The purpose of this technical report from a prospective pilot study was to illustrate magnetic resonance neurography (MRN) mapping of hand and nerve anatomy in amputees and incremental value of MRN over electrophysiology findings in pre-surgical planning of FAST-LIFE interface (robotic hand) patients.After obtaining informed consent, patients with upper extremity amputations underwent pre-operative 3-T MRN, X-rays, and electrophysiology. MRN findings were correlated with electrophysiology reports. Descriptive statistics were performed.Five patients of ages 21-59 years exhibited 3/5 partial hand amputations, and 2/5 transradial amputations on X-rays. The median and ulnar nerve end bulb neuromas measured 10.1 ± 3.04 mm (range: 5.5-14 mm, median: 10.5 mm) and 10.9 ± 7.64 mm (2-22 mm, 9.75 mm), respectively. The ADC of median and ulnar nerves were increased at 1.64 ± 0.1 × 103-T MRN allows excellent demonstration of forearm and hand nerve anatomy, altered diffusion characteristics, and their neuromas despite unremarkable electrophysiology for pre-surgical planning of the FAST-LIFE (robotic hand) interfaces.

Scoliosis is a common orthopedic problem in patients with neurofibromatosis 1 (NF1). Spinal deformities are found in 77% of all NF1 cases, with no widely accepted etiology. This study aimed to evaluate the frequency and types of scoliosis in NF1 patients using whole-body magnetic resonance imaging and to assess the association of intraspinal and paraspinal tumors with the imaging findings of scoliosis.A total of 122 NF1 patients with whole-body magnetic resonance imaging were found from the electronic medical records. Ninety-seven cases that met the inclusion criteria were identified. All patients underwent 3-T magnetic resonance imaging with automated software fusion of the 3 sets of short TI inversion recovery and 3-dimensional T1-weighted coronal images. Frequency and location of scoliosis and intraspinal and paraspinal tumors were recorded. Patients with severe dystrophic-type scoliosis were separately identified, and Cobb angles were measured for all such cases. Association analysis was performed. A P value less than 0.05 was considered statistically significant.Ninety-seven patients with NF1 were evaluated. Two had prior spinal surgery and were excluded. The final sample of 95 patients included 33 (35%) men and 62 (65%) women with a mean ± SD body mass index of 25.82 (4.96) kg/m2. Of the 95 patients, 43 (45.3%) had scoliosis, 13 of 43 (30.2%) of which were severely angled. Of the 95 patients, 25 (26.3%) had locoregional tumor presence. Intraclass correlation for Cobb angles measured 0.99 (confidence interval, 0.98-1.0). Fisher exact test determined no association between scoliosis and presence of either paraspinal or intraspinal tumors (P = 0.485). There was also no association between the tumors and severe dystrophic scoliosis (P = 1.0).This study found no association between the presence of locoregional spinal tumors and scoliosis in NF1 patients. This work adds to the body of knowledge of scoliosis in NF1 patients and infers that presence of scoliosis should not mandate immediate search for locoregional spinal tumors.

Dual energy CT (DECT) is becoming increasingly popular and valuable in the domain of musculoskeletal imaging. Gout maps and crystal detection have been predominant indications for about a decade. Other important indications of bone marrow maps and metal artifact reduction are also frequent with added advantages of detection and characterization of bone marrow lesions similar to MR imaging and diagnosis of hardware related complications, respectively. This article discusses technical considerations and physics of DECT imaging and its role in musculoskeletal indications apart from crystal imaging with respective case examples and review of the related literature. DECT pitfalls in these domains are also highlighted and the reader can gain knowledge of above concepts for prudent use of DECT in their musculoskeletal and general practices.

Purpose The single-session dose tolerance of the spinal nerves has been observed to be similar to that of the spinal cord in pigs, counter to the perception that peripheral nerves are more tolerant to radiation. This pilot study aims to obtain a first impression of the single-session dose-response of the brachial plexus using pigs as a model. Methods and Materials Ten Yucatan minipigs underwent computed tomography and magnetic resonance imaging for treatment planning, followed by single-session stereotactic ablative radiotherapy. A 2.5-cm length of the left-sided brachial plexus cords was irradiated. Pigs were distributed in 3 groups with prescription doses of 16 (n = 3), 19 (n = 4), and 22 Gy (n = 3). Neurologic status was assessed by observation for changes in gait and electrodiagnostic examination. Histopathologic examination was performed with light microscopy of paraffin-embedded sections stained with Luxol fast blue/periodic acid-Schiff and Masson's trichrome. Results Seven of the 10 pigs developed motor deficit to the front limb of the irradiated side, with a latency from 5 to 8 weeks after irradiation. Probit analysis of the maximum nerve dose yields an estimated ED50 of 19.3 Gy for neurologic deficit, but the number of animals was insufficient to estimate 95% confidence intervals. No motor deficits were observed at a maximum dose of 17.6 Gy for any pig. Nerve conduction studies showed an absence of sensory response in all responders and absent or low motor response in most of the responders (71%). All symptomatic pigs showed histologic lesions to the left-sided plexus consistent with radiation-induced neuropathy. Conclusions The single-session ED50 for symptomatic plexopathy in Yucatan minipigs after irradiation of a 2.5-cm length of the brachial plexus cords was determined to be 19.3 Gy. The dose-response curve overlaps that of the spinal nerves and the spinal cord in the same animal model. The relationship between the brachial plexus tolerance in pigs and humans is unknown, and caution is warranted when extrapolating for clinical use.

Glenohumeral osteoarthritis (GHOA) is a widely prevalent disease with increasing frequency due to population aging. Both clinical manifestations and radiography play key roles in the initial diagnosis, staging, and management decisions. Radiographic disease progression evaluation is performed using validated staging systems, such as Kellgren and Lawrence, Samilson, and Hamada. For young patients with mild to moderate GHOA and failed conservative treatment, arthroscopic preservation surgery (APS) is usually considered. Older patients and those with severe GHOA benefit from different types of arthroplasties. Preoperative magnetic resonance imaging (MRI) is essential for APS surgical planning, as it maps repairable labral, cartilage, and rotator cuff lesions. For arthroplasty planning, the status of glenoid cartilage and intactness of rotator cuff as well as glenoid morphology represent key factors guiding the decision regarding the most suitable hardware design, whether resurfacing, partial, total, or reverse joint replacement. Pre-surgical MRI or alternatively computed tomography arthrogram is employed to evaluate the cartilage and rotator cuff. Finally, three-dimensional computed tomography (3D CT) is indicated to optimally assess the glenoid morphology (to determine Walch classification, version, inclination, and bone loss) and analyze the necessity for glenoid osteotomy or graft augmentation to correct the glenoid structural abnormalities for future success and longevity of the shoulder implants or chosen constructs. Understanding the purpose of each imaging and treatment modality allows more efficient image interpretation. This article reviews the above concepts and details what a surgeon needs from a radiologist and could benefit from accurate reporting of preoperative imaging studies.

Aims Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. Methods The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). Results The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). Conclusion There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients. Cite this article: Bone Joint J 2022;104-B(9):1025–1031.

Foot and ankle amputation is a feared complication of diabetic neuropathy and diabetes mellitus (DM) accounts for 80% of all in-hospital amputations. Magnetic resonance neurography is an effective tool in characterizing neuromuscular sequelae of the disease. However, conventional ankle MRI is more commonly performed and has not been studied to assess neuromuscular changes of DM.The objective is to characterize neuromuscular changes of diabetic patients in a case-control study using conventional ankle MRI.Between November 2019 and July 2021, 110 consecutive ankle MRI scans (n = 102 patients) at our county hospital were reviewed and met the inclusion criteria. Patients were divided into two cohorts, diabetic (N = 63) and non-diabetic (N = 39). Demographics, HgbA1c, and reason for MRI study were collected via retrospective chart review. The presence of intramuscular edema-like signal, pattern of the edema, muscle fatty infiltration, and measurements of the cross-sectional area of the posterior, medial, and lateral tibial nerves (PTN, MPN, and LPN) was recorded blinded to the clinical findings by two readers.Muscle edema-like signal was much more likely to be found in DM (odds ratio 19.5, 95% CI 7.0-54.6, p 0.001). DM also showed increase of 0.87 in the mean grade of muscle fatty infiltration (p 0.001). There were higher rates of nerve T2 hyperintensity (odds ratio 14.0, 95% CI 3.1-62.7, p 0.001) and the measured areas of the PTN, MPN, and LPN were also larger in DM compared to their non-diabetic counterparts (PTN: 0.16 cmConventional ankle MRIs can be used to detect DM-related neuromuscular changes.

To determine which radiographic measures used to define the severity of hip dysplasia are associated with hip joint translation and to investigate relationships between position, body mass index, and joint translation.This is a cross-sectional retrospective study evaluating 10 validated radiographic measures of dysplasia on weight-bearing AP pelvis and supine 45-degree bilateral Dunn radiographs of 93 young adults with symptomatic hip dysplasia presenting to a single academic institution between October 2016 and May 2019. We determined the difference between standing and supine measurements for each hip and the correlation of each measure with the patient's body mass index.Femoral head extrusion index was 2.49% lower on supine X-ray (p = 0.0020). Patients with higher body mass index had higher center gap distance (p = 0.0274), femoral head extrusion (p = 0.0170), and femoral head lateralization (p = 0.0028) when standing. They also had higher Tönnis angle (pTranslation of the hip joint with position change is demonstrated by decreased femoral head extrusion index on supine X-ray. Patients with higher body mass index had more dysplastic hips, as measured by five of six radiographic outcomes of dysplasia, and experienced more translation with weight-bearing, reflected by increased femoral head lateralization.

This is an invited editorial on radiologist burnout, its presenting manifestations, toll on patient care and systems-based practice, and suggested remedies to mitigate stress and exhaustion.

The aims of the study were to systematically evaluate the sacroiliac joints of a consecutive series of patients with clinically suspected axial spondyloarthritis and to compare the diagnostic efficacy of 3-dimensional (3D) imaging versus conventional multisequence 2D techniques for sacroiliitis.In this cross-sectional multireader validation study, imaging studies of 104 consecutive patients with clinically suspected axial spondyloarthritis obtained with a rheumatology lumbosacral magnetic resonance imaging protocol were evaluated. Three-dimensional coronal oblique reconstructions parallel to the long axis of the sacrum were created. Two blinded readers evaluated 2D and 3D images separately for each study, and findings were compared with the reference standard for the final diagnosis and disease activity. Cohen κ and diagnostic performance measures on 2D and 3D imaging were evaluated and compared.With 2D versus 3D imaging, respectively, the sensitivity for detecting inflammatory cases was 57% versus 62% ( P = 0.1007), the sensitivity for detecting mechanical cases was 89% versus 76% ( P = 0.0312), the sensitivity for detecting active sacroiliitis was 49% versus 64% ( P = 0.0014), and the specificity for detecting active sacroiliitis was 87% versus 76% ( P = 0.0016). Interreader agreement of 2D imaging showed an overall range of κ = 0.27-0.85, and it was best for evaluation of bony ankylosis (κ = 0.85). Interreader agreement of 3D imaging was in an overall range of κ = 0.15-0.64.Single 3D isotropic magnetic resonance imaging provided adequate assessment of sacroiliac joints in this study and demonstrated significantly higher sensitivity and lower specificity for detecting active sacroiliitis. The initial results indicate that 3D imaging could be used for future works for screening sacroiliitis and abdominopelvic enthesopathy.

To test the diagnostic efficacy of a multiparametric rheumatology lumbosacral magnetic resonance (MR) imaging protocol in detection and characterization of axial spondylarthritis (SpA) and compare it with serology and clinical findings.A consecutive series of multiparametric rheumatology lumbosacral MR imaging examinations performed on 3T MR scanner. Three-dimensional inversion recovery turbo spin echo, precontrast and postcontrast fat-suppressed T1-weighted images, as well as diffusion-weighted images were used to detect active erosions and enthesitis using established criteria. Pearson χ2 was used for categorical variables. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were measured for magnetic resonance imaging (MRI) and serology, based on the final diagnosis from rheumatologists. An alpha error below 0.05 was considered statistically significant.The final study sample included 130 consecutive patients (80 women and 50 men; mean ± SD 44 ± 13 and 45 ± 14 years, respectively). Seventy-eight subjects were diagnosed with axial SpA and 52 with non-SpA arthropathy. In the non-SpA group, 27 patients were diagnosed with osteoarthritis, 6 had unremarkable imaging, whereas 19 were considered as clinically undetermined. There was positive correlation between positive MRI results and SpA diagnosis (P0.00001). No correlation existed between positive serology alone and SpA diagnosis (P = 0.0634). Although MRI and serology proved equally sensitive in detecting SpA, the specificity and overall accuracy of MRI were significantly higher. Inflammatory activity was detected in 45 (57.7%) cases, in the pelvic enthesis in 29 (37.2%) cases, in the lumbosacral spine in 16 (20.5%) cases, in the hip joints in 15 (19.2%) cases, and in the pubic symphysis in 5 (6.4%). Inactive sacral disease was seen in 7 of 35 enthesitis patients (20.0%), and in 2 SpA cases, there were no sacral lesions.The results suggest that in patients with suspected SpA, MRI should not be limited to the sacroiliac joints, but also include enthesitis sites and other joints of the axial skeleton. The multiparametric rheumatology protocol increases the efficacy of MRI in detecting enthesitis and joint inflammatory disease, thereby offering additional information to the clinician and assisting in the early diagnosis/detecting disease activity.